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Frontiers in Surgery 2023The pulmonary valve is the most frequently replaced cardiac valve in congenital heart diseases. Whether the valve alone or part of the right ventricular outflow tract... (Review)
Review
The pulmonary valve is the most frequently replaced cardiac valve in congenital heart diseases. Whether the valve alone or part of the right ventricular outflow tract have to be repaired or replaced depends on the specific pathological anatomy of the malformation. Once the decision to replace the pulmonary valve has been made, two options are available: the isolated transcatheter pulmonary valve replacement and the surgical implantation of a prosthetic valve either isolated or in combination with a procedure on the right ventricular outflow tract. In this paper, we will focus on the different past and present surgical options and present a new concept called "endogenous tissue restoration," a promising alternative to the hitherto existing implants. From a general point of view, neither the transcatheter nor the surgical valvular implants are magic bullets in the arsenal for the management of valvular diseases. Smaller valves have to be frequently replaced because of outgrowth of the patients, larger tissue valves may present late structural valve deterioration, while xenograft and homograft conduits may calcify and therefore become narrowed within unpredictable incidence and interval following implantation. Based on long-term research efforts combining the knowledge of supramolecular chemistry, electrospinning, and regenerative medicine, endogenous tissue restoration has emerged most recently as a promising option to create long-term functioning implants. This technology is appealing because following resorption of the polymer scaffold and timely replacement through autologous tissue, no foreign material remain at all in the cardiovascular system. Proof-of-concept studies as well as small first-in-man series have been completed and have demonstrated favorable anatomic and hemodynamic results, comparable to currently available implants in the short term. Based on the initial experience, important modifications to improve the pulmonary valve function have been initiated.
PubMed: 37334202
DOI: 10.3389/fsurg.2023.1185324 -
International Journal of Molecular... May 2023In peripheral nerve injuries (PNI) with substance loss, where tensionless end-to-end suture is not achievable, the positioning of a graft is required. Available options... (Review)
Review
In peripheral nerve injuries (PNI) with substance loss, where tensionless end-to-end suture is not achievable, the positioning of a graft is required. Available options include autografts (e.g., sural nerve, medial and lateral antebrachial cutaneous nerves, superficial branch of the radial nerve), allografts (Avance; human origin), and hollow nerve conduits. There are eleven commercial hollow conduits approved for clinical, and they consist of devices made of a non-biodegradable synthetic polymer (polyvinyl alcohol), biodegradable synthetic polymers (poly(DL-lactide-ε-caprolactone); polyglycolic acid), and biodegradable natural polymers (collagen type I with/without glycosaminoglycan; chitosan; porcine small intestinal submucosa); different resorption times are available for resorbable guides, ranging from three months to four years. Unfortunately, anatomical/functional nerve regeneration requirements are not satisfied by any of the possible alternatives; to date, focusing on wall and/or inner lumen organization/functionalization seems to be the most promising strategy for next-generation device fabrication. Porous or grooved walls as well as multichannel lumens and luminal fillers are the most intriguing options, eventually also including the addition of cells (Schwann cells, bone marrow-derived, and adipose tissue derived stem cells) to support nerve regeneration. This review aims to describe common alternatives for severe PNI recovery with a highlight of future conduits.
Topics: Animals; Humans; Swine; Sciatic Nerve; Polyesters; Peripheral Nerves; Prostheses and Implants; Peripheral Nerve Injuries; Polyglycolic Acid; Nerve Regeneration
PubMed: 37298122
DOI: 10.3390/ijms24119170 -
Journal of Medical Imaging and... Sep 2023Cadaveric studies suggest an increasing prevalence of the persistent median artery (PMA) over a prolonged timeframe. The aim of this retrospective cross-sectional study...
INTRODUCTION
Cadaveric studies suggest an increasing prevalence of the persistent median artery (PMA) over a prolonged timeframe. The aim of this retrospective cross-sectional study was to evaluate the PMA prevalence in haemodialysis patients who had computed tomographic fistulograms (CTFs), and if present, their calibres and origins.
METHODS
All consecutive adult patients referred for an upper limb CTFs for assessment of arteriovenous fistula (AVF) dysfunction from 2006 to 2021 were included. Patients whose CTF did not include the forearm were excluded. PMA was identified as an artery running alongside the median nerve between flexor digitorum superficialis and flexor digitorum profundus. Patient demographics, presence of PMA including size and origin were recorded.
RESULTS
A PMA was found in 91/170 (53.5%) CTFs (7:3 male-to-female ratio, mean age 71-years). When stratified by age, prevalence increased with decreasing age; 51% in >70-year-olds, 54% in 50-70-year-olds and 67% in <50-year-olds. The average PMA diameter was 2.2 mm proximally and 1.8 mm distally. No stenosis was observed in the PMAs.
CONCLUSION
The PMA prevalence appears to increase with decreasing age and is a frequently encountered anatomical variant. Radiologists assessing forearm vasculature need to be aware of this anatomical variant and potentially include it in their future reports. Further research into the PMA may make its potential use as arterial conduits for AVF, potential donor grafts for coronary artery bypass surgery or additional vascular access options possible. Whether the reducing prevalence with age reflects an overall increasing prevalence is yet to be determined.
Topics: Adult; Humans; Female; Male; Aged; Cross-Sectional Studies; Retrospective Studies; Radiography; Angiography; Arteries; Arteriovenous Fistula; Treatment Outcome
PubMed: 37277645
DOI: 10.1111/1754-9485.13544 -
PeerJ 2023The use of wild plants is considered to be an eco-friendly and promising natural resource. In sandy desert habitats, flourishes as a xerophytic shrub with high biomass...
The use of wild plants is considered to be an eco-friendly and promising natural resource. In sandy desert habitats, flourishes as a xerophytic shrub with high biomass production. As a dominant shrub in the arid sand dune habitats of Saudi Arabia, (Forssk.) Decne (Asclepiadaceae) is one of the most common xerophytes; the many medicinal uses of this plant include treating allergies, productive coughs, abortions, diabetes, stomach disorders, fevers, kidney disorders, and stones. In such a distribution, morpho-anatomical characteristics, among other adaptive traits, play an important role. This study aims to characterize some morpho-anatomical adaptations of in two stressful habitats: the hyper-arid inland sand dunes of the Empty Quarter (EQ) and the arid coastal sand dunes of Jazan. A morpho-anatomical analysis of plant stems and roots from both habitats was conducted using light microscopy (LM) and scanning electron microscopy (SEM). The outcomes indicated similar characteristics, a low surface-to-volume ratio (S/V), a thin boundary layer (δ), an epidermis with many layers of hypodermis, bundles of sclerenchymatous cells around vascular tissue, and storage starch grains in ray parenchyma between xylem conduits. On the other hand, the stem from the hyper-arid habitat of the Empty Quarter revealed more encrypted stomata, more elongated palisade cells, less calcium oxalate crystals with low Ca percentage, and a high vulnerability index of xylem vessels compared with the same traits of the stem from the Jazan coastal sand dunes habitat. Roots of from both habitats revealed similar features of general anatomy. However, differences in specific anatomical traits were observed, especially in xylem vessel characters. The vulnerability index of root xylem vessels from the Empty Quarter habitat was more than that from the Jazan coastal sand dunes habitat. Furthermore, vestured bordered pits in root xylem walls were more abundant in the Empty Quarter habitat than in the Jazan coastal sand dunes habitat. As a result, these characteristics in the morpho-anatomy of from both habitats provide practical adaptations to highly stressful conditions, along with specific anatomical traits relating to each habitat.
Topics: Apocynaceae; Sand; Saudi Arabia; Ecosystem; Biomass; Plants
PubMed: 37250712
DOI: 10.7717/peerj.15320 -
Ying Yong Sheng Tai Xue Bao = the... May 2023To deeply understand the effects of water and temperature factors on the xylem formation of , taking the Yingsu section in the lower reaches of Tarim River as an...
To deeply understand the effects of water and temperature factors on the xylem formation of , taking the Yingsu section in the lower reaches of Tarim River as an example, we selected micro-coring samples of around monitoring wells F and F in the 100 and 1500 m distance from the channel of Tarim River. We used wood anatomy method to analyze the xylem anatomy of and its response to water and temperature factors. The results showed that the changes of the total anatomical vessel area and the vessel number of in the two plots were basically consistent during the whole growing season. The vessel number of xylem conduits of increased slowly with the increases of groundwater depth, while the total conduit area increased firstly and then decreased. The total vessel area, minimum vessel area, average vessel area, and maximum vessel area of xylem increased significantly with the increases of temperature in the growing season. The contribution of groundwater depth and air temperature to xylem varied among different growth stages. In the early growing season, air temperature had the largest contribution to the number and total area of xylem conduits of . During the middle growing season, air temperature and groundwater depth jointly affected the parameters of each conduit. During the later growing season, groundwater depth had the largest contribution to the number and total area of conduits. Results of the sensitivity analysis indicated that the groundwater depth sensitive to xylem vessel number change of was 5.2 m and that to the change in the total conduit area was 5.9 m. The temperature sensitive to total vessel area of xylem was 22.0 ℃, and that to average vessel area was 18.5 ℃. Therefore, the sensitive groundwater depth affecting xylem growth was at the range of 5.2-5.9 m, and the sensitive temperature was at the range of 18.5-22 ℃. This study could provide scientific basis for the restoration and protection of forest in the lower reaches of Tarim River.
Topics: Populus; Hot Temperature; Rivers; Water; China; Wood; Xylem
PubMed: 37236941
DOI: 10.13287/j.1001-9332.202305.001 -
Advanced Biomedical Research 2023It is difficult to approach the Trigeminal Ganglion (TG) and Meckel's cave (MC) during surgeries. Therefore, the exact knowledge of the relationship of surgical...
BACKGROUND
It is difficult to approach the Trigeminal Ganglion (TG) and Meckel's cave (MC) during surgeries. Therefore, the exact knowledge of the relationship of surgical landmarks to related anatomical structures is vital to reduce the associated postoperative morbidity. The aim of the present study was to enhance the knowledge of the surgical anatomy of structures that are present in the conduit of all surgical approaches to TG and MC, their distances from surrounding neurovascular structures, and their variations.
MATERIAL AND METHODS
The study was carried out on 40 embalmed cadavers (Eight Female) of the anatomy department of a teaching hospital in Central India. Meticulous dissection of cranial fossae was done to locate TG, MC, and related anatomical structures. All distances from TG and MC were measured using an electronic digital calliper.
RESULTS
Length, width, and thickness of TG were 15.39 mm, 4.39 mm, and 2.54 mm, respectively. The distance from zygomatic arch, the lateral end of the petrous ridge, arcuate eminence, foramen ovale, and foramen spinosum to MC was 26.10 mm and 37.94 mm, 16.46 mm, 4.54 mm, and 11.23 mm, respectively. The sixth, fourth, and third cranial nerves were 6.26 mm, 4.94 mm, and 2.53 mm from MC, respectively. The MC was 42.72 mm and 33.87 mm anteromedial from posterior and anterior limits of the sigmoid sinus.
CONCLUSION
Findings of the present study will aid surgical planning and decide the approach to TG and MC and avoid surgical complications.
PubMed: 37200762
DOI: 10.4103/abr.abr_261_20 -
Annals of Vascular Surgery Nov 2023The Society for Vascular Surgery (SVS) developed objective performance goals (OPGs) for lower extremity bypass (LEB) in chronic limb-threatening ischemia (CLTI) based on...
BACKGROUND
The Society for Vascular Surgery (SVS) developed objective performance goals (OPGs) for lower extremity bypass (LEB) in chronic limb-threatening ischemia (CLTI) based on studies that included patients who were at good risk for open revascularization. In the endovascular era, many LEB patients have had prior interventions, and most would be considered high-risk by the original SVS OPG standards. The goal of this study is to characterize a contemporary patient population undergoing LEB for CLTI and determine if outcomes remain commensurate with the parameters established by the SVS OPG.
MATERIALS AND METHODS
All patients who underwent LEB for CLTI over a 10-year period (2012-2021) were identified. Patients were stratified into low- and high-risk categories based upon the clinical, conduit, and anatomic parameters used in the SVS OPG. Limb salvage at 1 year and amputation-free survival, a composite outcome of major amputation and mortality, at 1 year were compared with the SVS OPG cohort. Primary, assisted, and secondary patency at 1 and 3 years were also evaluated using Kaplan-Meier survival analysis.
RESULTS
There were 169 LEBs performed for CLTI. One hundred and two (60.36%) males, 101 (59.76%) current or former smokers, 115 (68.05%) with hypertension, 69 (40.83%) with diabetes mellitus, and 40 (23.67%) with coronary artery disease. Median age was 71.84 years, and mean follow-up was 2.17 years. 65 (38.46%) had a prior ipsilateral endovascular intervention, and 18 (10.65%) were redo bypasses. 21 (12.43%) were deemed clinically high-risk, 44 (26.04%) were high-risk conduits, and 118 (69.82%) had high-risk anatomic factors. Freedom from amputation at 1 year was 87.05% in this cohort which was similar to the overall SVS OPG cohort (88.9%). Amputation-free survival at 1 year was 77.78%, which was also similar to the overall SVS OPG cohort (76.5%). Primary patency at one and three years was 46.84% and 37.59%, assisted patency at one and three years was 61.87% and 44.81%, and secondary patency at one and three years was 72.13% and 61.16%.
CONCLUSIONS
The majority of patients undergoing LEB in the endovascular era meet the SVS OPG criteria for high risk. Despite this, the 1-year limb salvage and amputation-free survival in this cohort were equivalent to the SVS OPG LEB cohort. This supports the continued use of LEB for limb salvage in high-risk patients and those who have failed endovascular approaches.
Topics: Male; Humans; Aged; Female; Treatment Outcome; Ischemia; Peripheral Arterial Disease; Vascular Surgical Procedures; Limb Salvage; Risk Factors; Lower Extremity; Retrospective Studies; Endovascular Procedures
PubMed: 37169246
DOI: 10.1016/j.avsg.2023.04.027 -
Physiologia Plantarum 2023Interconduit pit membranes, which are permeable regions in the primary cell wall that connect to adjacent conduits, play a crucial role in water relations and the...
Interconduit pit membranes, which are permeable regions in the primary cell wall that connect to adjacent conduits, play a crucial role in water relations and the movement of nutrients between xylem conduits. However, how pit membrane characteristics might influence water-carbon coupling remains poorly investigated in cycads. We examined pit characteristics, the anatomical and photosynthetic traits of 13 cycads from a common garden, to determine if pit traits and their coordination are related to water relations and carbon economy. We found that the pit traits of cycads were highly variable and that cycads exhibited a similar tradeoff between pit density and pit area as other plant lineages. Unlike other plant lineages (1) pit membranes, pit apertures, and pit shapes of cycads were not coordinated as in angiosperms; (2) cycads exhibited larger pit membrane areas but lower pit densities relative to ferns and angiosperms, but smaller and similar pit membrane densities to non-cycad gymnosperms; (3) cycad pit membrane areas and densities were partially coordinated with anatomical traits, with hydraulic supply of the rachis positively coordinated with photosynthesis, whereas pit aperture areas and fractions were negatively coordinated with photosynthetic traits; (4) cycad pit traits reflected adaptation to wetter habitats for Cycadaceae and drier habitats for Zamiaceae. The large variation in pit traits, the unique pit membrane size and density, and the partial coordination of pit traits with anatomical and physiological traits of the rachis and pinna among cycads may have facilitated their dominance in a variety of ecosystems from the Mesozoic to modern times.
Topics: Ecosystem; Cycadopsida; Photosynthesis; Plants; Water; Carbon
PubMed: 37158623
DOI: 10.1111/ppl.13924 -
Annals of Pediatric Cardiology 2022Scimitar syndrome has been repaired by different surgical procedures including intracardiac baffle technique, reimplantation of scimitar vein (SV) to the right atrium or...
Scimitar syndrome has been repaired by different surgical procedures including intracardiac baffle technique, reimplantation of scimitar vein (SV) to the right atrium or the left atrium (LA). However, several anatomical variations such as short venous collector coursing deeply within the lung hilum with infradiaphragmatic drainage make the repair more challenging with conventional repair techniques. We present an alternative method for repair using a tube graft to connect the SV to the LA.
PubMed: 37152516
DOI: 10.4103/apc.apc_38_22 -
Journal of Gastrointestinal Surgery :... Aug 2023Endoscopic sleeve gastroplasty is an example of endoscopic sutured plications being used to remodel a gastrointestinal organ. With per-oral plication of the esophagus...
BACKGROUND
Endoscopic sleeve gastroplasty is an example of endoscopic sutured plications being used to remodel a gastrointestinal organ. With per-oral plication of the esophagus (POPE), similar plications are used to remodel the dilated and redundant megaesophagus of end-stage achalasia. Redundancies and dilations can also develop in the neoesophagus of a patient with prior esophagectomy. Megaesophagus and a redundant neoesophagus can both lead to debilitating dysphagia, regurgitation, and recurrent aspiration pneumonia. Traditionally, this anatomic problem requires complex revisional or excisional surgery, to which POPE offers an incisionless alternative.
METHODS
This is a dynamic manuscript with video demonstration of POPE, as well as review of five cases performed in 1 year. Data were collected in a prospectively maintained database, and the institutional review board approved retrospective review for this publication. The procedure is performed using a dual-channel upper endoscope fixed with an endoscopic suturing device, with the patient supine under general anesthesia.
RESULTS
POPE was technically completed in all cases with no serious complications, and patients either went home the same day or spent one night for observation. Most patients reported immediate and substantial symptomatic improvement. Objective pre- and post-measures include esophagram and nuclear gastric emptying studies.
CONCLUSION
This article discusses early experience at one institution with POPE, with detailed description of the procedure and technical considerations. An accompanying video reviews two cases, one with megaesophagus and one with a gastric conduit. While this novel procedure has limited and rare indications, it offers a low-morbidity solution to a challenging anatomic problem that traditionally requires invasive surgery.
Topics: Humans; Esophageal Achalasia; Feasibility Studies; Stomach; Gastroplasty; Treatment Outcome
PubMed: 37052876
DOI: 10.1007/s11605-021-05205-9